Housing Supportive Services in California’s Whole Person Care Pilots and ACA 2703 Health Home Program Brian Hansen Health Program Specialist II - Health Care Delivery Systems California Department of Health Care Services July 24, 2017
2 Presentation Overview 1. Whole Person Care (WPC) Pilot Program Overview 2. ACA 2703 Health Home Program (HHP) Overview California Department of Health Care Services
3 WPC Program Overview Program Duration Goal Funding • Five-year program • To test locally-based • $1.5 billion in federal authorized under the initiatives that will funds available to Medi-Cal 2020 1115 coordinate physical match local public funds Demonstration Waiver health, behavioral over five years health, and social • Up to $300 million services for annually is available beneficiaries who are • Based on semi-annual frequent users of reporting of multiple health care activities/interventions systems • Non-federal share provided via IGTs California Department of Health Care Services
4 Participating Entities Participating Entities must Allowable Lead Entities include at least: • County • One (1) Medi-Cal managed care health plan • City • One (1) Health services • A health or hospital authority agency/department • A designated public hospital • One (1) Specialty mental • A district/municipal public health agency/department hospital • One (1) Public • A federally recognized tribe/ agency/department tribal health program • Two (2) Community partners • A consortium of any of the above entities California Department of Health Care Services
5 Target Populations WPC pilots identify high-risk, high-utilizing Medi-Cal beneficiaries in their geographic area. • Pilots work with participating entities to determine the best target population(s) and areas of need. Target population(s) may include, but are not limited to, individuals: • With repeated incidents of avoidable emergency use, hospital admissions, or nursing facility placement; • With two or more chronic conditions; • With mental health and/or substance use disorders; • Who are currently experiencing homelessness, or at risk of homelessness. California Department of Health Care Services
6 Expected Pilot Size - Population Larger: Large: Medium: Small: Over 100,000 Between Between 1,000 Between 250 10,000 and and 5,000 and 800 100,000 Kern Alameda Monterey Orange Contra Costa Napa San Bernardino Los Angeles Riverside San Diego Placer San Joaquin Santa Clara Shasta San Mateo San Francisco Solano Ventura
7 WPC Pilot Activities/Services • Build Infrastructure: To integrate services among local entities that serve the target population through collaboration procedures, governance, and information sharing data systems and processes. • Provide Services: To cover activities (not otherwise reimbursed by Medicaid) to improve care for the target population. All populations receive intensive, whole-person case management. • Operate Plan-Do-Study-Act: For quarterly rapid-cycle quality improvement. California Department of Health Care Services
8 WPC Tenancy Supportive Services • Individual Housing Transition Services: Services to assist beneficiaries with obtaining housing, such as individual outreach and assessments, searching for housing, communicating with landlords, and coordinating moves. • Individual Housing & Tenancy Sustaining Services: Services to support individuals in maintaining tenancy once housing is secured, such as tenant and landlord education and tenant coaching. California Department of Health Care Services
9 WPC Additional Supports • Transportation that is not covered by Medicaid. • Environmental accommodations for accessibility. • Other one-time supports, such as security deposits, utility set-up fees, first month coverage of utilities, one-time cleaning prior to occupancy, etc. California Department of Health Care Services
10 WPC Innovative Services : • Recuperative Care/Medical Respite: Up to 90 days of residential care after an acute discharge to allow recovery in a stable environment. • Sobering Centers: Up to 24 hours of residential care to avoid ED or Jail utilization. • Field-based Care: Case managers, therapists, or nurses delivering services on the streets or at shelters. • Benefits Advocacy and Legal Assistance: To enroll in benefits, such as SSI, and remove barriers to benefit enrollment, health care, and housing. California Department of Health Care Services
11 Health Homes Program (HHP) • The HHP will begin a staged rollout in 2018 and will be available in most areas of California in 2019. • Like most Medi-Cal benefits, the HHP will be administered through managed care plans (MCPs). • Plans will contract with community providers, such as FQHCs, for most services. • State legislation requires program cost neutrality. There will be a focus on evaluating savings in inpatient, ED, etc. • Eligibility includes specific physical and behavioral health conditions. • State Health Homes legislation was cosponsored by the Corporation for Supportive Housing and includes frequent utilizers who are experiencing homelessness. • Eligibility is focused on the top 2-4% of the highest risk members who are living in the community. California Department of Health Care Services
12 SPA Supportive Housing Services • California’s draft Health Home SPA is under CMS review. • The draft Health Home SPA services include tenancy supports referenced in CMS’s June 26, 2015, bulletin “Coverage of Housing Related Activities and Services for Individuals with Disabilities:” • Individual Housing Transition Services; and • Individual Housing and Tenancy Sustaining Services. • These services fit the definition of Health Home case management and the needs of our target population. • Coverage is not available for one-time set up services, such as housing modifications, first month rent and deposit, etc. California Department of Health Care Services
13 HHP Service Requirements • MCPs have the flexibility to organize the provision of service with their community providers to maximize effectiveness: • For example, services like engagement of homeless members can be subcontracted to providers with specific expertise in the community. • The Health Home service team will include a Housing Navigator for members experiencing chronic homelessness. • MCPs will provide services to members in the community, including at home and on the streets as needed. • MCPs will to use local community based providers with experience serving homeless members. • Reporting requirements will track members who have been homeless, their services, and housing status. California Department of Health Care Services
14 Resource Assumptions • DHCS will develop a capitated, risk-based, add-on payment for each enrolled HHP member, which will be paid to the MCP. • In the development of MCP rates, DHCS will consider additional resource needs that can impact program success for those experiencing homelessness: • Resources needed for members with varying levels of acuity/complexity, including behavioral health conditions; • Engagement efforts to get members into the program; and • Higher levels of initial resource utilization for new members. California Department of Health Care Services
15 Program Monitoring • MCPs have the flexibility to contract for services and rates to meet the specific needs in their area, for their providers, and to fit their model. • DHCS will verify that MCPs have a viable model for: • A complete network of providers to meet all service needs; and • Provider contract requirements, a payment model, and an oversight process to ensure higher-need members receive a higher level of service. • Through our monitoring processes, DHCS will also compare actual MCP resource utilization to: • DHCS rate development assumptions, and • DHCS program service requirements. California Department of Health Care Services
16 DHCS Web Page Links Whole Person Care Pilots • http://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx • Or Google “DHCS Whole Person Care Program” ACA 2703 Health Home Program • http://www.dhcs.ca.gov/services/Pages/HealthHomesProgram.aspx • Or Google “DHCS Health Home Program” California Department of Health Care Services
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